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Open Access 01-05-2020 | Spondyloarthropathy | Original Article

Presence of active MRI lesions in patients suspected of non-radiographic axial spondyloarthritis with high disease activity and chance at conversion after a 6-month follow-up period

Authors: Tamara Rusman, Marie-Luise B. John, Mignon A. C. van der Weijden, Bouke J. H. Boden, Carmella M. A. van der Bijl, Stefan T. G. Bruijnen, Conny J. van der Laken, Mike T. Nurmohamed, Irene E. van der Horst-Bruinsma

Published in: Clinical Rheumatology | Issue 5/2020

Abstract

Objectives

The primary aim is to evaluate signs of inflammation on MRI of sacroiliac joints (SIJ)/spine in inflammatory back pain (IBP) patients suspected of nr-axSpA with high disease activity. Secondary aims are to describe the onset of new inflammatory lesions at MRI after 6 months and to evaluate gender differences in the presence of inflammation.

Method

Consecutively, patients with IBP with at least two spondyloarthritis features, high disease activity (BASDAI ≥ 4), and who were TNFi naïve, had a MRI of SIJ and spine. In the absence of active lesions, MRI was repeated after 6 months. MRI images were scored according to the Spondyloarthritis Research Consortium of Canada method.

Results

Sixty-nine patients were included (53% female), of whom 39% showed signs of inflammation at the first MRI: 30.9% of the SIJ, 19.1% of the spine and 2.4% at both sites, irrespective of the CRP levels. Males more often showed inflammatory signs at the MRI of the SIJ and spine compared with females (45.5% vs. 33.3%). Consistently, the median SPARCC score was higher in males: for SIJ 14.0 (IQR 2.3–25.0) and for spine 11.5 (IQR 8.5–25.6). Only one patient (4.7%) without baseline inflammatory signs showed active lesions of SIJ after 6 months.

Conclusions

Almost 40% of the IBP patients suspected of nr-axSpA, with high disease activity, showed inflammatory lesions on MRI of SIJ and/or spine, which occurred more often in males compared with females. In the majority (95.3%), an MRI without inflammatory lesions remained negative after 6 months despite high disease activity.

Key Points

• Forty percent of inflammatory back pain patients with high disease activity showed inflammatory signs on MRI of the SIJ and/or spine.

• Only 4% of baseline MRIs without inflammatory signs at baseline conversed to an MRI with inflammatory signs after 6 months.

• Male inflammatory back pain patients with high disease activity showed more often inflammatory signs on MRI compared with females.

Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J et al (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783CrossRef

Rudwaleit M, Sieper J (2012) Referral strategies for early diagnosis of axial spondyloarthritis. Nat Rev Rheumatol 8:262–268CrossRef

Poddubnyy D, Rudwaleit M, Haibel H, Listing J, Marker-Hermann E, Zeidler H et al (2011) Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 70:1369–1374CrossRef

van Onna M, Jurik AG, van der Heijde D, van Tubergen A, Heuft-Dorenbosch L, Landewe R (2011) HLA-B27 and gender independently determine the likelihood of a positive MRI of the sacroiliac joints in patients with early inflammatory back pain: a 2-year MRI follow-up study. Ann Rheum Dis 70:1981–1985CrossRef

van den Berg R, de Hooge M, Rudwaleit M, Sieper J, van Gaalen F, Reijnierse M, Landewé R, Huizinga T, van der Heijde D (2013) ASAS modification of the Berlin algorithm for diagnosing axial spondyloarthritis: results from the SPondyloArthritis Caught Early (SPACE)-cohort and from the Assessment of SpondyloArthritis international Society (ASAS)-cohort. Ann Rheum Dis 72:1646–1653CrossRef

Calin A, Porta J, Fries JF, Schurman DJ (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237:2613–2614CrossRef

van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368CrossRef

Rudwaleit M, van der Heijde D, Khan MA, Braun J, Sieper J (2004) How to diagnose axial spondyloarthritis early. Ann Rheum Dis 63:535–543CrossRef

Sieper J, Rudwaleit M (2005) Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis 64:659–663CrossRef

10.

Bruijnen ST, van der Weijden MA, Klein JP, Hoekstra OS, Boellaard R, van Denderen JC et al (2012) Bone formation rather than inflammation reflects ankylosing spondylitis activity on PET-CT: a pilot study. Arthritis Res Ther 14:R71CrossRef

11.

Maksymowych WP, Inman RD, Salonen D, Dhillon SS, Krishnananthan R, Stone M, Conner-Spady B, Palsat J, Lambert RG (2005) Spondyloarthritis Research Consortium of Canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis. Arthritis Rheum 53:502–509CrossRef

12.

Maksymowych WP, Inman RD, Salonen D, Dhillon SS, Williams M, Stone M, Conner-Spady B, Palsat J, Lambert RG (2005) Spondyloarthritis Research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum 53:703–709CrossRef

13.

Rudwaleit M, Jurik AG, Hermann KG, Landewe R, van der Heijde D, Baraliakos X et al (2009) Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 68:1520–1527CrossRef

14.

van den Berg R, de Hooge M, Bakker PA, van Gaalen F, Navarro-Compan V, Fagerli KM et al (2015) Metric properties of the SPARCC score of the sacroiliac joints-data from baseline, 3-month, and 12-month followup in the SPACE cohort. J Rheumatol 42:1186–1193CrossRef

15.

Sieper J, van der Heijde D, Dougados M, Mease PJ, Maksymowych WP, Brown MA, Arora V, Pangan AL (2013) Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1). Ann Rheum Dis 72:815–822CrossRef

16.

Landewe R, Braun J, Deodhar A, Dougados M, Maksymowych WP, Mease PJ et al (2014) Efficacy of certolizumab pegol on signs and symptoms of axial spondyloarthritis including ankylosing spondylitis: 24-week results of a double-blind randomised placebo-controlled phase 3 study. Ann Rheum Dis 73:39–47CrossRef

17.

Sieper J, van der Heijde D, Dougados M, Maksymowych WP, Scott BB, Boice JA et al (2015) A randomized, double-blind, placebo-controlled, sixteen-week study of subcutaneous golimumab in patients with active nonradiographic axial spondyloarthritis. Arthritis Rheumatol 67:2702–2712CrossRef

18.

Bakker PA, Ez-Zaitouni Z, van Lunteren M, van den Berg R, De Hooge M, Fagerli KM et al (2016) Are additional tests needed to rule out axial spondyloarthritis in patients ages 16-45 years with short-duration chronic back pain and maximally one spondyloarthritis feature. Arthritis Care Res (Hoboken) 68:1726–1730CrossRef

19.

Braun J, Baraliakos X, Hermann KG, Landewe R, Machado PM, Maksymowych WP et al (2017) Effect of certolizumab pegol over 96 weeks of treatment on inflammation of the spine and sacroiliac joints, as measured by MRI, and the association between clinical and MRI outcomes in patients with axial spondyloarthritis. RMD Open 3:e000430CrossRef

20.

Maksymowych WP, Dougados M, van der Heijde D, Sieper J, Braun J, Citera G, van den Bosch F, Logeart I, Wajdula J, Jones H, Marshall L, Bonin R, Pedersen R, Vlahos B, Kotak S, Bukowski JF (2016) Clinical and MRI responses to etanercept in early non-radiographic axial spondyloarthritis: 48-week results from the EMBARK study. Ann Rheum Dis 75:1328–1335CrossRef

21.

van der Heijde D, Sieper J, Maksymowych WP, Lambert RG, Chen S, Hojnik M et al (2018) Clinical and MRI remission in patients with nonradiographic axial spondyloarthritis who received long-term open-label adalimumab treatment: 3-year results of the ABILITY-1 trial. Arthritis Res Ther 20:61CrossRef

22.

Bakker PA, Ramiro S, Ez-Zaitouni Z, van Lunteren M, Berg IJ, Landewe R et al (2019) Is it useful to repeat MRI of the sacroiliac joints after three months or one year in the diagnostic process of patients with chronic back pain suspected of axial spondyloarthritis. Arthritis Rheumatol 71:382–391CrossRef

23.

Maksymowych WP, Wichuk S, Dougados M, Jones H, Szumski A, Bukowski JF et al (2017) MRI evidence of structural changes in the sacroiliac joints of patients with non-radiographic axial spondyloarthritis even in the absence of MRI inflammation. Arthritis Res Ther 19:126CrossRef

24.

Weber U, Zubler V, Zhao Z, Lambert RG, Chan SM, Pedersen SJ, Østergaard M, Rufibach K, Maksymowych WP (2015) Does spinal MRI add incremental diagnostic value to MRI of the sacroiliac joints alone in patients with non-radiographic axial spondyloarthritis. Ann Rheum Dis 74:985–992CrossRef

25.

Ez-Zaitouni Z, Bakker PA, van Lunteren M, de Hooge M, van den Berg R, Reijnierse M et al (2017) The yield of a positive MRI of the spine as imaging criterion in the ASAS classification criteria for axial spondyloarthritis: results from the SPACE and DESIR cohorts. Ann Rheum Dis 76:1731–1736CrossRef

Title: Presence of active MRI lesions in patients suspected of non-radiographic axial spondyloarthritis with high disease activity and chance at conversion after a 6-month follow-up period
Authors: Tamara Rusman
Marie-Luise B. John
Mignon A. C. van der Weijden
Bouke J. H. Boden
Carmella M. A. van der Bijl
Stefan T. G. Bruijnen
Conny J. van der Laken
Mike T. Nurmohamed
Irene E. van der Horst-Bruinsma
Publication date: 01-05-2020
Publisher: Springer London
Keywords: Spondyloarthropathy
Back Pain
Back Pain
Back Pain
Published in: Clinical Rheumatology / Issue 5/2020
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04885-8

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